The first people who should warn women who have had any lymph nodes removed (for biopsies when they have breast cancer) about developing lymphedema are their doctors. Oncologists, nurse practitioners, radiologists and other doctors should be aware of the risks of their patients developing lymphedema in the arm or arms when any amount of lymph nodes are taken out of the armpit. Women with breast cancer who have radiation treatments also run the risk of having their lymph nodes damaged.
Lymphedema is a chronic type of swelling that isn’t fatal. But once a woman develops Stage II to Stage III and IV lymphedema, she can not be cured of the disease, only treated, and treatments require lifelong maintenance.
Once a woman who has breast cancer and had lymph nodes removed, she should be informed immediately about lymphedema risks, safety factors and prevention. Unfortunately, most specialists and doctors fail to even mention lymphedema to their patients with breast cancer. Most doctors know very little about lymphedema since the lymphatic system is one of the least studied systems in the body.
Now why should all airlines inform their patrons about lymphedema? Once in the air, the cabin pressure is low. People who run the risk of developing lymphedema may easily develop chronic swelling in their arms (or other limbs, depending on which lymph nodes or lymph vessels are affected) once in air. Most of my patients are women who develop lymphedema after they board airplanes without wearing compression sleeves and gloves/gauntlets. These women had had lymph nodes removed from their armpits for biopsies to rule out cancer in their nodes. They are breast cancer survivors.
As a rule of thumb, according to the National Lymphedema Network, anyone who has had any amount of lymph nodes removed, regardless of whether or not she has visible swelling, should wear compression garments when boarding a plane. Compression garments provide an external pressure that prevents lymph fluid from pooling in the skin, which leads to lymph swelling, otherwise known as lymphedema. For a woman who has had right armpit lymph nodes removed, she should wear a compression sleeve and a compression gauntlet or glove, pressure gradient of 20-30 mmhg. The garments should fit snugly but feel like second skin, so there shouldn’t be any bunching, wrinkles, or any tourniquet areas (too tight). For the legs, compression garments should have a starting pressure of 30-40 mmhg.
If a doctor can prescribe the compression garments, most surgical supply stores can fill the order and charge a patient’s insurance. With our health advances, it’s a shame so many women have to live with chronic lymphedema after they have combated breast cancer. I believe it’s not just the responsibility of health professionals to warn their patients about lymphedema prevention and safety factors. All airlines should do the same, because a majority of the cases of women developing lymphedema in the United States occurs after breast cancer survivors board airplanes without wearing the appropriate compression garments.
I am also surprised planes don’t warn people about DVTs (deep vein thrombosis) and risk reduction by just wearing compression stockings. I wonder if airlines are liable, should patrons die from developing DVTs and subsequently PEs, pulmonary embolisms, from prolonged plane rides. Or if women develop chronic lymphedema from the low cabin pressure. Hopefully, more health professionals and women become aware of lymphedema risks and prevention.
Kat Lieu, Doctor of Physical Therapy, Certified Lymphedema Therapist.